Journal of Tissue Viability RSS feed: Articles in Press. The Journal of Tissue Viability is the official publication of the Tissue Viability Society and is a quarterly journal concerned with all aspects of the occurrence and treatment of wounds, ulcers and pressure sores including patient care, pain, nutrition, wound healing, research, prevention, mobility, social problems and management. The Journal particularly encourages papers covering skin and skin wounds but will consider articles that discuss injury in any tissue. Articles that stress the multi-professional nature of tissue viability are especially welcome. We seek to encourage new authors as well as well-established contributors to the field - one aim of the journal is to enable all participants in tissue viability to share information with colleagues.http://www.journaloftissueviability.com//inpress?rss=yesElsevier Inc.en © 2010 Tissue Viability Society. Published by Elsevier Inc. All rights reserved. Journal of Tissue Viability0965-206X2010-07-09 © 2010 Tissue Viability Society. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journaloftissueviability.com/article/PIIS0965206X10000380/abstract?rss=yesAbstract: Rationale: Dried amniotic membrane contains collagen matrix and key bioactive molecules like fibronectin, laminin, glycosaminoglycans and elastin. Fresh and cryopreserved human amniotic membrane has been widely explored as a biological dressing. However, fresh and cryopreserved amniotic membranes are not readily available or require special storage conditions. This investigation was aimed to study the functional and clinical efficacy of air-dried radiation sterilized amniotic membranes as dressing in burn wound care.Methods: Amniotic membranes collected from placentae of screened donors were processed and sterilized by gamma radiation at 25 kGy. The fluid handling capacity, shelf life and clinical efficacy of air-dried gamma-irradiated amniotic membranes was evaluated.Results: Fluid handling capacity of the air-dried irradiated amniotic membrane dressing was 3.79–4.2 g/10 cm2 in 24 h. Infrared (IR) spectral scanning showed no degradation or change in the dried gamma-irradiated amniotic tissue after 2 and 5 years of storage. No effect of storage on the impermeability of the processed amniotic membranes to bacteria was observed. The dried gamma-irradiated amniotic membranes even after 5 years of storage provided an effective barrier to microbial penetration. The dried amniotic membranes were applied to 22 cases of scald, flame and electrical burns. Of the 22 patients studied, 19 patients had excellent results in the form of complete epithelialization of wound with an average healing time of 15–25 days.Conclusion: IR studies and microbial permeability test indicate no qualitative changes in the material property of dried gamma-irradiated amniotic membranes after 2 and 5 years of storage. Air-dried amniotic membrane with the advantage of storage at room temperature as well as functional efficiency is an ideal dressing for burn wound care.Dried gamma-irradiated amniotic membrane as dressing in burn wound care - Corrected ProofRita Singh, M.P. Chacharkar10.1016/j.jtv.2010.06.001Journal of Tissue Viability (2010)2010-07-09Journal of Tissue Viability2010-07-09BASIC RESEARCHhttp://www.journaloftissueviability.com/article/PIIS0965206X10000409/abstract?rss=yesAbstract: Heel ulcers are common, dangerous and costly, but their etiology is poorly understood and no biomechanical studies were conducted to explore it. This paper describes a biomechanical investigation of heel ulcers using a theoretical model that characterizes the internal mechanical loading at the soft tissues of a supported heel. The study is aimed first at identifying some heel-ulcer-specific risk factors pointed out by the biomechanical theory, and second, at demonstrating the kind of support that biomechanical theory and computer modeling can offer in the conduct of clinical studies in the pressure ulcer field. The modeling demonstrated that atypical foot anatomies characterized by heavy-weight foot, sharp posterior calcaneus and thin soft tissue padding are theoretically more prone to heel ulcers. Diabetes and edema at the feet were also predicted to impose risks for heel ulcers, which agrees very well with clinical observations. This paper therefore demonstrated that a biomechanical theory can be used to explain and interpret clinical and epidemiological findings related to heel ulcers.The biomechanics of heel ulcers - Corrected ProofAmit Gefen10.1016/j.jtv.2010.06.003Journal of Tissue Viability (2010)2010-06-28Journal of Tissue Viability2010-06-28http://www.journaloftissueviability.com/article/PIIS0965206X10000355/abstract?rss=yesAbstract: Background: A study has found that major amputations are necessary on 69% of ischemic diabetic foot patients treated with conventional therapy. An uncontrolled study of 31 patients showed that only 33% needed major amputation after treatment with conventional therapy plus De Marco Formula (DMF), a novel formulation of procaine and Polyvinylpyrrolidone.Objective: To assess the tolerability and safety of the combination of conventional therapy and De Marco Formula for infected ischemic diabetic foot.Methods: Adult patients, 10 male/24 female, were treated with the conventional therapy for diabetic foot plus DMF (0.15ml/kg/day IM) during ten days and then twice a week until healing of the lesions or completion of a 52-day period. Required amputations, lesion areas, adverse events occurrence and clinical laboratory parameters (hemoglobin, blood cell counts, glycosilated hemoglobin, total proteins, creatinine, alanine transaminase and alkaline phosphatase) were determined during the treatment period.Results: Two slight (5.88%) and one moderate (2.94%) adverse events (mainly cutaneous rash) were reported. The last one was reported on the 15th day of treatment and DMF dosing was discontinued by patient’s request. Clinical laboratory mean values remained within normal ranges during treatment except for blood leukocyte counts that pathologically elevated at baseline and decreased to normality by treatment end. This study has found that 18.08% of patients (N=6) needed a lower limb amputation with the combined treatments. The standard reported rate in Cuba is 25–29%. Furthermore, a progressive reduction of the mean lesion area from 51.29cm2 at the beginning to 1.89cm2 at the end of the treatment (p=0.000001) was observed.Conclusion: The treatment with De Marco Formula for 52 days as an adjuvant for the conventional therapy for infected ischemic diabetic foot was well tolerated and safe. These findings are consistent with those of a randomized prospective controlled study performed later.Tolerability and safety of conventional therapy combination with DeMarco formula for infected ischemic diabetic foot - Corrected ProofHéctor Álvarez Duarte, Martha M. Fors López, José Hernández Carretero, Miriam Mahia Vilas, Milagros García Mesa10.1016/j.jtv.2010.03.002Journal of Tissue Viability (2010)2010-06-07Journal of Tissue Viability2010-06-07CLINICAL STUDYhttp://www.journaloftissueviability.com/article/PIIS0965206X10000379/abstract?rss=yesAbstract: Objective: At present, the evidence regarding the type of mattress that is the best for preventing pressure ulcers is not convincing. In a single center, prospective, controlled trial we compared a static air overlay mattress (no electric pump needed) on top of a cold foam mattress with a cold foam mattress alone on pressure ulcer incidence in nursing home residents.Methods: 83 Patients were included in the study with a score lower than 12 points on the Norton scale and no pressure ulcer at the start of the study. 42 Patients received a cold foam mattress and 41 patients received a static air overlay on top of that cold foam mattress. Out of bed we standardized the pressure reduction in sitting position by using a static air cushion in both groups. Patients were checked weekly in both groups for pressure ulcers.Only when there were signs of developing a pressure ulcer grade 2 or higher, repositioning by our nursing home pressure ulcer protocol (PU protocol) was put into practice.Results: Seven patients (17.1%) on a cold foam mattress and two (4.8%) on a static air mattress developed a pressure ulcer grade 2 or more. There was no difference regarding pressure ulcer incidence between patients with a high risk (Norton 5–8) and patients with a medium risk (Norton 9-12). In 5 out of 7 patients who developed a pressure ulcer on a foam mattress the ulcers showed no healing using our PU protocol. In the static air group all pressure ulcers healed by regular treatment according to our PU protocol.Conclusions: In this study, static air overlay mattresses provided a better prevention than cold foam mattresses alone (4.8% versus 17.1%). The Norton scores of the patients in both groups did not change during the 6 month trial period. Our decision to use repositioning only when there were signs of a pressure ulcer seems to be acceptable when a static air overlay is in position. However, the score of 17.1% development (incidence) of pressure ulcers in the foam group may stress the need of repositioning when using only this type of mattress.Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home - Corrected ProofMartin van Leen, Steven Hovius, Jacques Neyens, Ruud Halfens, Jos Schols10.1016/j.jtv.2010.04.001Journal of Tissue Viability (2010)2010-06-01Journal of Tissue Viability2010-06-01CLINICAL STUDYhttp://www.journaloftissueviability.com/article/PIIS0965206X10000343/abstract?rss=yesAbstract: Aims and Objectives: To compare three risk assessment scales with respect to predictive validityBackground: In paediatrics there are several competing scales and at least ten published paediatric pressure ulcer risk assessment scales have been identified. However there are few studies exploring the validity of such scales, and none identified that compares paediatric risk assessment scales.Design: Cross sectional studyMethods: Three risk assessment scales, Braden Q, Garvin and Glamorgan, were compared. The total scores and sub-scores were tested to determine if children with pressure ulcers were significantly different from those with no pressure ulcer.Logistic regression was conducted to determine if the probability of developing a pressure ulcer was a better predictor of development of pressure ulcer compared with the total score of each scale. Receiver operating characteristic curves were computed and the area under the curve used to compare the performance of the risk assessment scales.Results: Data from 236 children were collected. 71 were from children in eleven hospitals who were asked to provide data on children with pressure ulcers (although seventeen did not have a pressure ulcer) of whom five were deep (grade 4). A sample of 165 were from one hospital, of which seven had a pressure ulcer, none grade four.The Glamorgan risk assessment scale had a higher predictive ability than either the Braden Q or Garvin. The mobility sub-score of each of the risk assessment scales was the most predictive in each case.Conclusions: The Glamorgan scale is the most valid of the three paediatric risk assessment scales studied in this population. Mobility alone may be as effective as employing the more complex risk assessment scale.Relevance to clinical practice: If a paediatric risk assessment scale is employed to predict risk, then unless it is valid, it may identify children who are not at risk and waste resources, or fail to identify children at risk possibly resulting in adverse health outcomes.A comparison of Braden Q, Garvin and Glamorgan risk assessment scales in paediatrics - Corrected ProofDenis Anthony, Jane Willock, Mona Baharestani10.1016/j.jtv.2010.03.001Journal of Tissue Viability (2010)2010-04-26Journal of Tissue Viability2010-04-26BASIC RESEARCHhttp://www.journaloftissueviability.com/article/PIIS0965206X10000367/abstract?rss=yesAbstract: Background: High-molecular-weight sodium heparin (10,000 IU) has been developed based on studies conducted on burn patients; it has anti-inflammatory, antigenic and anticoagulant properties.Objectives: The aim of this paper was to evaluate the effects of topical application of sodium heparin spray on two immunosuppressed patients (a child and a young person) with perineal dermatitis and an immunosuppressed child with second-degree burns.Methods: This is a report of three clinical cases treated in a pediatric hospital. Sodium heparin spray (10,000 IU) was applied at a dose of 4200 IU per percentage of body surface area affected over the hyperemic region. Heparin spray treatment was discontinued after crust formation and wound reepithelialization; essential fatty acid was applied until spontaneous separation of the crust or total wound reepithelialization.Results: Heparin spray had analgesic, angiogenic and anti-inflammatory effects, and did not require secondary wound closure. Pain control was of fundamental importance to the patients; in the three cases, improvement in analgesia was achieved within 24 h of treatment.Conclusion: The topical application of heparin spray in patients with perineal dermatitis or superficial second-degree burns demonstrated good tolerability, resulted in good aesthetic outcomes, and reduced pain.Effects of topical application of 10,000 IU heparin on patients with perineal dermatitis and second-degree burns treated in a public pediatric hospital - Corrected ProofJulieta Maria Ferreira Chacon, Maria Lydia Mello de Andrea, Leila Blanes, Lydia Masako Ferreira10.1016/j.jtv.2010.03.003Journal of Tissue Viability (2010)2010-04-21Journal of Tissue Viability2010-04-21CASE REPORThttp://www.journaloftissueviability.com/article/PIIS0965206X09000667/abstract?rss=yesAbstract: People with spinal cord injuries are at high risk for developing pressure ulcers. Increased skin temperature is one of the extrinsic causative factors for this multi-factorial disease. Previous animal studies revealed that local skin cooling reduced the severity of ulceration, and cooling is widely used in plastic surgery and organ transplants for tissue preservation. The objectives of this pilot study were to develop test protocols and instrumentation and to investigate the effect of local cooling on skin perfusion response to pressure on young healthy human subjects. Reactive hyperemia was quantified in this study to compare the effects of pressure with and without cooling. Reactive hyperemia is a normal physiological response occurring after vessel occlusion. Laser Doppler flowmetry was used to measure skin blood flow. Time-dependent spectral analysis was used to analyze and decompose the blood flow data into frequency ranges associated with specific blood flow control mechanisms. The study used a repeated measures design with two test conditions: 8kPa of pressure with and without cooling to 25°C. We hypothesized that local cooling would reduce the post-ischemic reactive hyperemic response induced by the rigid indenter. Time series results showed that normalized peak perfusion response was significantly lower with cooling (p=0.019). Time-dependent spectral analysis results suggested that both metabolic and myogenic responses contribute to this protective effect. Findings from our study on humans were consistent with previous animal studies. Additional studies on individuals with spinal cord injury are planned to further evaluate the cooling effect in a high-risk population.Effects of local cooling on sacral skin perfusion response to pressure: Implications for pressure ulcer prevention - Corrected ProofYi-Ting Tzen, David M. Brienza, Patricia Karg, Patrick Loughlin10.1016/j.jtv.2009.12.003Journal of Tissue Viability (2010)2010-02-12Journal of Tissue Viability2010-02-12http://www.journaloftissueviability.com/article/PIIS0965206X0900062X/abstract?rss=yesAbstract: Introduce a reliable stowage by means of syringe to preserve split-thickness-skin grafts.A reliable stowage by means of syringe for preserving split-thickness-skin grafts - Corrected ProofYu-Yin Wang, Ji-Yong He, Xiao-Ping Liu, Xiao-Fang Li10.1016/j.jtv.2009.10.005Journal of Tissue Viability (2010)2010-01-20Journal of Tissue Viability2010-01-20CLINICAL STUDYhttp://www.journaloftissueviability.com/article/PIIS0965206X09000588/abstract?rss=yesAbstract: Risk assessment scales are widely used to measure the risk of pressure ulcers in the clinical area. They have been subject to many validation studies; however these have focused on the predictive ability of the scales.We have conducted several studies that consider the validity of pressure ulcer risk assessment scales. We have reviewed these and revisited the data in some cases to conduct additional tests of validity presented for the first time in this paper.Based on these results, and a review of the literature, we have come to the conclusion that while the scales are probably reliable, and do assess risk:The complexity of risk assessment scales does not appear to be warranted. There is evidence that clinical judgment is as effective in assessing risk as risk assessment scales. Reduction in pressure ulcer incidence after implementation of risk assessment tools is likely to be an example of the Hawthorn effect.We believe risk assessment scales are useful research tools, but may not be useful in clinical practice.Do risk assessment scales for pressure ulcers work? - Corrected ProofDenis Anthony, Panos Papanikolaou, Sam Parboteeah, Mohammad Saleh10.1016/j.jtv.2009.11.006Journal of Tissue Viability (2009)2009-12-25Journal of Tissue Viability2009-12-25REVIEWhttp://www.journaloftissueviability.com/article/PIIS0965206X09000606/abstract?rss=yesAbstract: This short review summarizes the localization and effects of the plant lectin soybean agglutinin (SBA) on the injured and non-injured organ-cultured rat corneal endothelium. Although the tissue exists as a non-cycling monolayer on the posterior corneal surface a circular freeze injury promotes wound repair as cells initiate DNA synthesis, mitosis and migration. As a result, by 24 h post-injury, endothelial cells express a surface protein that binds SBA in a diffuse punctate pattern, which by 48 h after injury, becomes confined to the cell periphery. As healing proceeds, SBA binding dramatically declines, such that, only scattered binding is observed by 72 h after wounding. In non-injured organ-cultured endothelia, weak SBA binding appears 24 h after explanation but becomes prominently detected around the cell periphery by 48 h. Incubating injured or non-injured endothelia in SBA leads to alterations in their cellular appearance due to the fact that lectin exposure results in the disruption of the actin cytoskeleton. Although this does not affect migration, treatment with either SBA or N-acetylgalactosamine (the SBA binding sugar) does interfere with the reestablishment of cell–cell contact. It is postulated that the surface protein that binds SBA is expressed during conditions that are stressful to the tissue. During organ-culture the protein's appearance suggests a cellular response to explantation in order to enhance or maintain monolayer integrity. In wound repair its appearance may serve to establish preliminary cell–cell contact during the restoration of the endothelial monolayer.The effects of soybean agglutinin binding on the corneal endothelium and the re-establishment of an intact monolayer following injury – A short review - Corrected ProofSheldon R. Gordon10.1016/j.jtv.2009.11.008Journal of Tissue Viability (2009)2009-12-21Journal of Tissue Viability2009-12-21REVIEWhttp://www.journaloftissueviability.com/article/PIIS0965206X09000576/abstract?rss=yesAbstract: Loss of adipose tissue can occur due to congenital and acquired lipoatrophies, trauma, tumor resection, and chronic disease. Clinically, it is difficult to regenerate or reconstruct adipose tissue. The extensive microvsacular network present in adipose, and the sensitivity of adipocytes to hypoxia, hinder the success of typical tissue transfer procedures. Materials that promote the formation of vascularized adipose tissue may offer alternatives to current clinical treatment options. A number of synthetic and natural biomaterials common in tissue engineering have been investigated as scaffolds for adipose regeneration. While these materials have shown some promise they do not account for the unique extracellular microenvironment of adipose. Adipose derived hydrogels more closely approximate the physical and chemical microenvironment of adipose tissue, promote preadipocyte differentiation and vessel assembly in vitro, and stimulate vascularized adipose formation in vivo. The combination of these materials with techniques that promote rapid and stable vascularization could lead to new techniques for engineering stable, vascularized adipose tissue for clinical application. In this review we discuss materials used for adipose tissue engineering and strategies for vascularization of these scaffolds.Clinical Relevance: Materials that promote formation of vascularized adipose tissue have the potential to serve as alternatives or supplements to existing treatment options, for adipose defects or deficiencies resulting from chronic disease, lipoatrophies, trauma, and tumor resection.Materials for engineering vascularized adipose tissue - Corrected ProofYu-Chieh Chiu, Ming-Huei Cheng, Shiri Uriel, Eric M. Brey10.1016/j.jtv.2009.11.005Journal of Tissue Viability (2009)2009-12-14Journal of Tissue Viability2009-12-14CLINICAL STUDYhttp://www.journaloftissueviability.com/article/PIIS0965206X09000564/abstract?rss=yesAbstract: Fibroblasts are one of the most abundant cell types in connective tissues. These cells are responsible for tissue homeostasis under normal physiological conditions. When tissues are injured, fibroblasts become activated and differentiate into myofibroblasts, which generate large contractions and actively produce extracellular matrix (ECM) proteins to facilitate wound closure. Both fibroblasts and myofibroblasts play a critical role in wound healing by generating traction and contractile forces, respectively, to enhance wound contraction. This review focuses on the mechanisms of force generation in fibroblasts and myofibroblasts and techniques for measuring such cellular forces. Such a topic was chosen specifically because of the dual effects that fibroblasts/myofibroblasts have in wound healing process– a suitable amount of force generation and matrix deposition is beneficial for wound healing; excessive force and matrix production, however, result in tissue scarring and even malfunction of repaired tissues. Therefore, understanding how forces are generated in these cells and knowing exactly how much force they produce may guide the development of optimal protocols for more effective treatment of tissue wounds in clinical settings.Fibroblasts and myofibroblasts in wound healing: Force generation and measurement - Corrected ProofBin Li, James H.-C. Wang10.1016/j.jtv.2009.11.004Journal of Tissue Viability (2009)2009-12-08Journal of Tissue Viability2009-12-08BASIC RESEARCHhttp://www.journaloftissueviability.com/article/PIIS0965206X09000382/abstract?rss=yesAbstract: Aim: The achievement of a well-healed wound depends on many factors including its size and location on the body and the properties of the skin. The aim of this study is to develop computational wound closure models and compare the results of using different excision shapes.Methods: Finite element models were developed that simulated the incision, excision and closure of skin. Skin was represented by an orthotropic constitutive law. The size of extrusions, maximum stresses and the force to close wounds with differently shaped excisions were analysed.Results: Circular excisions resulted in closed wounds with extrusion heights 76% larger than fusiform or lazy S-plasty excisions. The extrusion length for circular excisions was 50% longer than the lazy S-plasty extrusion length. The maximum stresses around closed wounds with elliptical excisions were between 30 and 40% lower than the maximum stresses around fusiform and lazy S-plasty closed wounds. The force required to close an elliptical wound was between 27 and 66% lower than the closure force of fusiform and lazy S-plasty excisions. The orthotropic nature of skin and the orientation of the excision significantly influence the behaviour of the skin around the closed wound. The in vivo pre-stress, often ignored in wound closure models, influences the size of extrusions. Increasing the pre-stress by a factor of twenty decreased extrusion heights by 40%. A similar change in pre-stress decreased extrusion lengths by 50%.Conclusion: These models have potential as valuable clinical tools to determine the optimum excision shape that will minimise adverse stress fields and reduce scarring. Models that are patient-specific would be useful to design strategies to ensure favourable healing and improve the quality of life of the person.Finite element models of wound closure - Corrected ProofCormac Flynn10.1016/j.jtv.2009.10.001Journal of Tissue Viability (2009)2009-11-30Journal of Tissue Viability2009-11-30CLINICAL STUDY